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Riedel R, Fassunke J, Scheel AH, Scheffler M, Heydt C, Nogova L, Michels S, Fischer RN, Eisert A, Scharpenseel H, John F, Ruge L, Schaufler D, Siemanowski J, Ihle MA, Wagener-Ryczek S, Pappesch R, Rehker J, Bunck A, Kobe C, Keil F, Merkelbach-Bruse S, Büttner R, Wolf J. MET Fusions in NSCLC: Clinicopathologic Features and Response to MET Inhibition. J Thorac Oncol 2024; 19:160-165. [PMID: 37429463 DOI: 10.1016/j.jtho.2023.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION MET fusions have been described only rarely in NSCLC. Thus, data on patient characteristics and treatment response are limited. We here report histopathologic data, patient demographics, and treatment outcome including response to MET tyrosine kinase inhibitor (TKI) therapy in MET fusion-positive NSCLC. METHODS Patients with NSCLC and MET fusions were identified mostly by RNA sequencing within the routine molecular screening program of the national Network Genomic Medicine, Germany. RESULTS We describe a cohort of nine patients harboring MET fusions. Among these nine patients, two patients had been reported earlier. The overall frequency was 0.29% (95% confidence interval: 0.15-0.55). The tumors were exclusively adenocarcinoma. The cohort was heterogeneous in terms of age, sex, or smoking status. We saw five different fusion partner genes (KIF5B, TRIM4, ST7, PRKAR2B, and CAPZA2) and several different breakpoints. Four patients were treated with a MET TKI leading to two partial responses, one stable disease, and one progressive disease. One patient had a BRAF V600E mutation as acquired resistance mechanism. CONCLUSIONS MET fusions are very rare oncogenic driver events in NSCLC and predominantly seem in adenocarcinomas. They are heterogeneous in terms of fusion partners and breakpoints. Patients with MET fusion can benefit from MET TKI therapy.
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Affiliation(s)
- Richard Riedel
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Jana Fassunke
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Andreas H Scheel
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Matthias Scheffler
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Carina Heydt
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Lucia Nogova
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Sebastian Michels
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Rieke N Fischer
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Anna Eisert
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Heather Scharpenseel
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Felix John
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Lea Ruge
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Diana Schaufler
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Janna Siemanowski
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Michaela A Ihle
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Svenja Wagener-Ryczek
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Roberto Pappesch
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Jan Rehker
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Anne Bunck
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Radiology, University of Cologne, Cologne, Germany
| | - Carsten Kobe
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Felix Keil
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Sabine Merkelbach-Bruse
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Reinhard Büttner
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Jürgen Wolf
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany.
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Riedel R, Fassunke J, Tumbrink HL, Scheel AH, Heydt C, Hieggelke L, Scheffler M, Heimsoeth A, Nogova L, Michels S, Weber JP, Fischer RN, Eisert A, Westphal T, Schaufler D, Siemanowski J, Ihle MA, Wagener-Ryczek S, Castiglione R, Pappesch R, Rehker J, Jürgens J, Stoelben E, Bunck A, Kobe C, Merkelbach-Bruse S, Sos ML, Büttner R, Wolf J. Resistance to MET inhibition in MET-dependent NSCLC and therapeutic activity after switching from type I to type II MET inhibitors. Eur J Cancer 2023; 179:124-135. [PMID: 36521334 DOI: 10.1016/j.ejca.2022.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/30/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Resistance to MET inhibition occurs inevitably in MET-dependent non-small cell lung cancer and the underlying mechanisms are insufficiently understood. We describe resistance mechanisms in patients with MET exon 14 skipping mutation (METΔex14), MET amplification, and MET fusion and report treatment outcomes after switching therapy from type I to type II MET inhibitors. MATERIALS AND METHODS Pre- and post-treatment biopsies were analysed by NGS (next generation sequencing), digital droplet PCR (polymerase chain reaction), and FISH (fluorescense in situ hybridization). A patient-derived xenograft model was generated in one case. RESULTS Of 26 patients with MET tyrosine kinase inhibitor treatment, eight had paired pre- and post-treatment biopsies (Three with MET amplification, three with METΔex14, two with MET fusions (KIF5B-MET and PRKAR2B-MET).) In six patients, mechanisms of resistance were detected, whereas in two cases, the cause of resistance remained unclear. We found off-target resistance mechanisms in four cases with KRAS mutations and HER2 amplifications appearing. Two patients exhibited second-site MET mutations (p.D1246N and p. Y1248H). Three patients received type I and type II MET tyrosine kinase inhibitors sequentially. In two cases, further progressive disease was seen hereafter. The patient with KIF5B-MET fusion received three different MET inhibitors and showed long-lasting stable disease and a repeated response after switching therapy, respectively. CONCLUSION Resistance to MET inhibition is heterogeneous with on- and off-target mechanisms occurring regardless of the initial MET aberration. Switching therapy between different types of kinase inhibitors can lead to repeated responses in cases with second-site mutations. Controlled clinical trials in this setting with larger patient numbers are needed, as evidence to date is limited to preclinical data and case series.
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Affiliation(s)
- Richard Riedel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany
| | - Jana Fassunke
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | - Hannah L Tumbrink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Translational Genomics, Germany
| | - Andreas H Scheel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | - Carina Heydt
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | - Lena Hieggelke
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | - Matthias Scheffler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany
| | - Alena Heimsoeth
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Translational Genomics, Germany
| | - Lucia Nogova
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany
| | - Sebastian Michels
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany
| | - Jan-Phillip Weber
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany
| | - Rieke N Fischer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany
| | - Anna Eisert
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany
| | - Theresa Westphal
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany
| | - Diana Schaufler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany
| | - Janna Siemanowski
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | - Michaela A Ihle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | - Svenja Wagener-Ryczek
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | | | - Roberto Pappesch
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | - Jan Rehker
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | - Jessica Jürgens
- Lung Clinic Merheim, Hospital of the City of Cologne, University of Witten-Herdecke, Germany
| | - Erich Stoelben
- Lung Clinic Merheim, Hospital of the City of Cologne, University of Witten-Herdecke, Germany
| | - Anne Bunck
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Radiology, Germany
| | - Carsten Kobe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Nuclear Medicine, Germany
| | - Sabine Merkelbach-Bruse
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | - Martin L Sos
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Translational Genomics, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Molecular Medicine Cologne, Germany
| | - Reinhard Büttner
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Molecular Medicine Cologne, Germany
| | - Jürgen Wolf
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany.
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